Kingswells - Small Animal 01224 740700

Bridge of Don 01224 826121

Kingswells - Farm and Equine 01224 740700

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Kingswells - Small Animal 01224 740700

Bridge of Don 01224 826121

Kingswells - Farm and Equine 01224 740700

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For URGENT referrals please call 01224 740700.

Referring Vet Details

Veterinary Surgeon*:

Practice*:

Best contact number for vet*:

Email Address (for referral report)*:

Client Details

Client Name*:

Address*:

Telephone Number*:

Email address*:

Patient Details

Name*:

Age of Patient*:

Sex of Patient*:

Breed*:

Height of Patient*:

Known allergies or adverse reactions:

Insured?:

Insurance Company:

Referral Details

Referral Service Requested*:

Lameness
Medicine (including colic)
Mass removal (including laser)
Surgery
Gastroscopy
Airway endoscopy
Guttural pouch endoscopy
Ultrasound – orthopaedic
Ultrasound – abdominal
Radiography
Dental
Shockwave
Reproduction
Chemotherapy
Cardiology

History giving rise to referral*:

Treatment given including timings*:

Any other comments:

If referral for procedure only please state here:

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Company's registered name: Independent Vetcare Ltd

Registered number: 07746795

Registered Address: The Chocolate Factory, Keynsham, Bristol BS31 2AU

Authorised and regulated by the Financial Conduct Authority for credit-related regulated activities under reference number: FRN738010

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